Patient and caregiver education levels and readmission and mortality rates of congestive heart failure patients

Background: Despite evidence that effective family support improves health behaviour and outcomes, the nature of the correlation between congestive heart failure [CHF] outcome and caregiver contribution has not been well studied.

Aim: This single centre pilot study aimed to determine epidemiological correlations between education level and hospital readmission and mortality rates of CHF patients in a nonwestern country population.

Methods: The study was performed in King Abdullah Medical City, Makkah, Saudi Arabia from February 2015 to February 2016, and included 167 consecutive patients enrolled in a CHF management registry. Data on the education levels of patients and their caregivers were collected, and patient outcomes in high education level [HEL] and low education level [LEL] groups were compared.

Results: Of 167 patients, 101 completed 12 months of follow-up. The mean age was 58 [13.4] years and 80% were men; 87% were Saudi nationals. The HEL group comprised 42 [42%] patients. There were no significant differences in the mortality [3 vs 2%] or readmission rate [18 vs 19%] between the LEL and HEL patients, and 29.6% of LEL patients had caregivers with an LEL.

Conclusion: The education levels of CHF patients and caregivers were not correlated with readmission or mortality rates

Effect of cigarette smoking on liver functions: a comparative study conducted among smokers and non-smokers male in El-beida City, Libya.

Tobacco use is widely spread throughout the world. The effect of smoking on human health are serious and in many cases, deadly. The present study was done to investigate the effect of cigarette smoking on some liver functions in male population in El-beida city, Libya. The study was carried out on thirty Libyan male smokers, who smoked at least 10 cigarettes per day for at least15 years. The group includes smokers with age range between 30-60 years. Non-smokers, (control, n= 30) group were collected with the same range of age for statistical comparison. The whole blood samples were drawn by venipuncture from each member and liver functions test were estimated by a kit method on automatic analyzer (Beckman BUN analyzer, USA). The results of the study revealed a significant increase of malondialdehyde (MDA), which is an indicator of lipid peroxidation and oxidative stress significantly increased in cigarette smokers in groups when compared with control group. While the plasma level of total protein, albumin and total bilirubin decreased during smoking. Cigarette smoking raised alkaline phosphatase (ALP), alanine aminotrans-ferase (ALT), aspartate aminotransferase (AST), plasma total cholesterol and triglycerides in smoker group when compared with non-smoker group. To conclude, cigarette smoking leads to oxidative stress by free radical generation by the mechanism of lipid peroxidation. Smoking exerts negative influence on liver functions test should be carefully interpreted, and further study on the mechanism of the effects is warranted.

Effect of cigarette smoking on liver functions: a comparative study conducted among smokers and non-smokers male in El-beida City, Libya.

Tobacco use is widely spread throughout the world. The effect of smoking on human health are serious and in many cases, deadly. The present study was done to investigate the effect of cigarette smoking on some liver functions in male population in El-beida city, Libya. The study was carried out on thirty Libyan male smokers, who smoked at least 10 cigarettes per day for at least15 years. The group includes smokers with age range between 30-60 years. Non-smokers, (control, n= 30) group were collected with the same range of age for statistical comparison. The whole blood samples were drawn by venipuncture from each member and liver functions test were estimated by a kit method on automatic analyzer (Beckman BUN analyzer, USA). The results of the study revealed a significant increase of malondialdehyde (MDA), which is an indicator of lipid peroxidation and oxidative stress significantly increased in cigarette smokers in groups when compared with control group. While the plasma level of total protein, albumin and total bilirubin decreased during smoking. Cigarette smoking raised alkaline phosphatase (ALP), alanine aminotrans-ferase (ALT), aspartate aminotransferase (AST), plasma total cholesterol and triglycerides in smoker group when compared with non-smoker group. To conclude, cigarette smoking leads to oxidative stress by free radical generation by the mechanism of lipid peroxidation. Smoking exerts negative influence on liver functions test should be carefully interpreted, and further study on the mechanism of the effects is warranted.

[Capability of enamel matrix derivative to induce dentine after pulp capping in humans]

Amelogenins from ameloblast play an important rule in differentiating odontoblasts in dental papilla, suggesting that amelogenins may associate with odontoblasts changes during development. Aim In the present study we have investigated the effects of enamel matrix derivative [EMD] on the healing of pulpal wound and formation of reperative dentin. Sixty human premolars scheduled for orthodontic extraction were divided into two groups. Coronal pulp tissue was exposed after class V buccal cavity preparatin. Under rubber dam isolation, the exposed pulps in group one were capped by Emdogain [Biora AB, Malmo, Sweden], and the other group served as controls and were capped by calcium hydroxide past [Dycal]. The cavities in both groups were sealed by glass-ionomer cement [Ketec fill]. After 2 weeks, 4 weeks and 2 months teeth were extracted [10 teeth for every interval] and prepared for histopathological study. In EMD- treated teeth, Rapid formation of new dentin-like hard tissue was observed and significant statistical was found from control group [p

Prospective evaluation of emergency extracorporeal shock wave lithotripsy versus expectant treatment in the management of acute obstructing ureteral stone

Objectives: in the present study, we evaluate prospectively the efficacy and safety of emergency ESWL [eESWL] in the management of acute renal colic with obstructing ureteric calculi. That is resistant to medical treatment

Patients and Methods: the study involved 220 patients presented by acute renal colic due to obstructing ureteral stones. Of whom 190 patients. [155 men and 35 women] complete the follow-up period. The mean age of these patients was 37 years range between 18-67 years. Stones are

Results: pain completely resolved After ESWL in 70% of the patients, additional medical treatment in 24% and persistent in 6%. On average the pain decrease by 75% after ESWZ according to visual pain scale reference. The rate of recurrence of the acute renal colic decreased significantly after ESWL [P= 0.01]. ESWL decreased the complication rate of acute obstructing stones by almost 50% and the average hospital stay by 2.6 days. The overall rate of successful stone clearance after ESWL was 85% [range 80% to 88.8%]. The overall rate of spontaneous stone passage after medical treatment was 66.3% [range 17.6% to 94%]. For distal ureteral stones =/>5mm there was no significant difference in the stone clearance and the hospital stay between the 2 groups [94% Vs 86.6%. and 1.1 Vs 1.3 days, for group 1 and 2, respectively]

Conclusion: emergency ESWL is a suitable alternative treatment for persistent acute renal colic secondary to obstructive ureteral stones. It resolves the pain in most of the patients and decreases the hospital stay and the complication rate. However, it is not a suitable treatment modality for distal ureteral stone 55 mm unless it is done for severe and persistent pain

Management of erectile dysfunction in patients with ischemic heart disease by intracavernous injection of vasoactive drugs because of failure, complications or contraindication of sildenafil

The aim of the present study was to evaluate the effectiveness of intracavemous injection [ICI] of vasoactive drugs combination in patients with ischemic heart disease [IHD] and erectile dysfunction [ED] who were not proper cadidatefor treatment with sildenafil citrate. The study population included 122 selected patients with IHD and ED in whom sildenafil was not an option because of its failure, side effects, or presence of contraindication for its use. The ICI program consisted of two combinations of vasoactive drugs. The first combination [A] included a mixture of papaverine, phen-tolamine, and verapamil The second combination [B] included a mixture of the former 3 drugs plus prostaglandin El. Patients who failed to respond with the first combination were switched to the second combination. A positive response was defined as an erection sufficient for vaginal penetration and maintained till ejaculation. A positive response was achieved with combination [A] in 67 [54.9%] of the 122 patients and with combination [B] in 24 [43.6%] of the remaining 55 patients. The total success rate was [74.6%]. Patients with positive response [91 pts.] were followed-up for one year with 80 [87.9%] patients reported successjid coitus during this period. The remaining 11 patients [12.1%] dropped out of the program, 2 [2.2%] because of treatment failure, and 9 [9.9%] because of marital and health reasons. Adverse effects of ICI therapy included prolonged erection in 10 [11%], painful erection in 9 [9.9%], subcutaneous hematoma in 7 [7.7%], and plaque formation in 3 [3.3%]. We conclude that ICI ofvasoactive drugs is a good alternative for the treatment of ED in patients with IHD in whom stidenafil is not anoption

role of sildenafil citrate in treatment of erectile dysfunction in- Egyptian men with stable ischemic heart disease

Erectile dysfunction [ED] is a common condition in men with cardiovascular disease [CVD]. Risk factors for ED include many of the same risk factors for CVD. Sildenafil is-an oral phosphodiesterase inhibitor that enhances erectile function through the same general pathway used by nature. Two hundred Egyptian patients with IHD and ED were included in the study. They had a clinical diagnosis of ED of at least 12 months duration. All were in a stable relation with their female partner. In addition to symptoms, one positive objective test for myocardial ischemia was mandatory as an inclusion criterion. Exclusion criteria included, patients with unstable angina pectoris, recent myocardial infarction [< 6 weeks]. Patients were also excluded if they had penile anatomical defects or if they were dependent on nitrate therapy, In some patients, if their clinical state allowed, nitrate therapy was stopped 24 hours before sildenafil administration. Patients were also excluded if they had any significant concomitant medical condition that would impair participation in the study. Patients were classified into 2 groups; group A included 100 patients who received sildenafil citrate [viagra, D- fizer Inc]. The other 100 patients represent group B and they received matching placebo. The dosage of sildenafil citrate was started as 50 mg, which could be adjusted to 100 mg or 25 mg. based on efficacy and tolerability. Efficacy was assessed using end-of-treatment responses to Question 3 [ability to achieve an erection] and Question 4 [ability to maintain an erection] of the 15-question International Index of Erectile function [IIEF] that includes scores for the 5 domains of male sexual function assessed by the IIEF [i.e. erectile function orgasmic function sexual desire intercourse satisfaction, and overall satisfaction] and responses to a global efficacy question ["Did the treatment improve your erections?"]. The responses to the 2 IIEF questions, which assessed treatment out comes, were graded on a scale of I [almost never or never] to 5 [almost always or always], with a score of 0 indicating no attempt at sexual intercourse. As regards efficacy, the mean score for question 3 [achieving an erection] and question. 4 [maintaining an erection] of the IIEF for patients with ED and IHD were significantly higher for group A [sildenafil group] than for group B [placebo group] [P < 0.0001]. The mean score for the orgasmic function domain, the sexual desire domain, the intercourse satisfaction domain and, the overall satisfaction domain were significantly higher for the sildenafil group [all P < 0.05]. At the end of treatment improved erection were reported in 61% of patients with IHD in sildenafil group. and by 3% of patients in placebo group [P < 0.0001]. There were no significant difference between both groups as regards major side effects as unstable angina,myocardial infarction and sudden death.. The most common minor complications, which included headache. flushing, and dyspepsia, were significantly higher in sildenafil group. Because there is small but definite risk of having a cardiac event with sexual activity, physicians should discuss with their cardiac patients the risk of sexual activity before prescribing any treatment for ED. Physicians should evaluate their patients cardiac status when considering the safety of administration of' any ED treatment that may have systemic vasodilatory properties and can potentially lower blood pressure the results of this study showed that oral sildenafil is effective and well tolerated in treatment of erectile dysfunction in Egyptian patients with stable coronary artery disease who are not on nitrate therapy

Hypospadias repair using combined tissues transfer

Purpose: Buccal mnucosa graft used successfully to treat hypospadic patient with deficient penile skin. Tunica vaginalis flap proved its usefulness in repairing recurrent urethral fistula. We evaluate the results of combining both technques in management of penile hypospadias with insufficient senile skin. Patients and Between June 96 and June 99 we treated 25 hvpospadic patients, 3 circumcised and 22 redo cases, using buccal mucosa onlay graft. Hypospadcas was anterior penile in 6 and mid penile in 19 cases. Tunica vaginalis flap was used to cover the buccel graft in the last cases. Excellent functioal and cosmetic results were achieved in [56%] of cases following the operation. The success rate raised to [84%] after management of minor complications. Minor complications in 7 patients were in the form of minor fistula [16%], mild meatal retraction [4%], meatal stenosis [16%] and mild posterior stricture [8%]. Major complications were big fistula [8%] and complete failure of the procedure [8%]. No fistula occurred in cases in whom Tuncia vaginalis graft was used. Buccal mucosa onaly graft is a suitable material in hypospadias repair. Covering the graft with tunica vaginalis flap significantly decreases the incidence of fistula. Preservation of the uiethral plate decreases the size of grafting material

Minimaly invasive therapy for localized infiltrating bladder cancer in comparison with radical cystectomy

Purpose: We analyzed the long-term results of aggressive transurethral resection plus intravesical B.C.G. for the treatment of patients with localized muscle infiltrating bladder cancer in comparison to radical cystectomy regarding its efficacy, recurrence rate, survival rate, quality of life and patient satisfaction. Patients and A total of 118 patients with locally invasive transitional cell carcinoma T2 and T3A were included in the study. Seventy two patients [group I] underwent radical cystectomy, while 46 patients [group II] treated by aggressive repeated iransurethral resection until negative biopsies of the muscle layer of the depth and periphery of the tumer bed were obtained. B.C. G. was intravesically instilled in single 6-week course [150 mg/ instillation] then monthly for one year. The avenge follow-up period of group I was 60.5 months [36 - 70] and for group II was 62 months [42 - 65]. Patients were evaluated postoperatively every 3 momhs for 2 years and then every 6 months thereafter by urine cytology, cystescopy, biopsy, ultrasonography and metastatic evaluation. A comparative non-randomized study was performed for both groups, At 5-years average follow-up, cause specific survival rates were 72.4%, 66.6%, 61.1% and 60% in group I according to the stage and grade of the tumer, while it was 68.8%, 66.4%, 58.3% and 50% in group II with no statistical significant differences [p > 0.05]. The recurrence rates ranged from 24.4% to 36.3% in group I according to the stage and grade of the tumor, while it was ranged from 26.3% to 50% in group II which an apparent increase in the recurrence rates in group II which was not significant. Bladder preservation in group II ranged from 78.9% to 66.6% at average 5-year follow-up postoperativelly. Aggressive repeated transurethral resection and B.C.G. intravesical instillation is justified when the tumor is clinically limited to the muscle layer and when all biopsies of the periphery and depth of the tumor bed show muscular tissue negative for tumor cells. This modality of treatment is effective and comparable to radical cystectomy In some selected patients with small localized infiltrating transitional cell carcinoma stage T2, T3 A. moreover, it avoids the morbidity and change in quality of lif associated with radical cystectomy

Local injection of antibotic in refractory chronic bacterial prostatitis

Prostatitis is a widespread condition in men with an estimated prevalence of 10%. When there is a good clinical and bacteriological evidence of infection, systemic antibiotic therapy is usually prescribed on a long-term basis. This therapy is not optimal because of its high coast and significant side effects with a high relapse rate. As such we have evaluated the role of local intraprostatic injection of antibiotic in patients with resistant chronic bacterial prostatitis. Patients and A total of 54 patients diagnosed as having chronic bacterial prostatitis, based on a positive culture of either expressed prostatic secretion [EPS] or post massage urine specimen [VB3] or both, were enrolled in this study. Patients were injected locally with either a combination therapy of aminoglycoside and cephalosporin [group I, 17 patients] or pefloxacin [group II, 37 patients]. Administration of the antibiotic was performed either via a transperineal route [13 cases] or via a TRUS guided injection [41 cases] in the echogenic zone or external gland. Patients were injected once per week for 3 consecutive weeks. Patients were followed- up for a period ranged from12 to 25 months with an average of 15 months. Follow-up was lost in 8 patients. The bacteriologic cure was regarded only when the culture of both EPS andVB3 was negative.The bacteriologic cure rate was 46,7% for the combination therapy group and 67.8% for the pefloxacin group. Clinical improvement was higher than bacteriologic cure in both groups.Relapse and reinfection occurred in [53.3%] after an average of 10 months and in [31.2%] after an average of 15 months in the combination therapy and pefloxacin groups respectively. A significant difference in the success rate was observed between groups [p-value <0.05]. Few complications as perineal pain, proctalgia hematuria and hemospermia were reported. Direct antibiotic infiltration of the prostate in patients with CBP offers a new hopeful method in the treatment of this condition. Combination therapy with aminoglycoside and cephalosporin gave a satisfactory clinical and bacteriologic cure. Pefloxacin quinolone antibiotic achieved a superior result and opened a new field of medical therapy for this resistant disease